Court Orders Medi-Cal To Move To Cover HIV-Positive Californians

A court order is requiring the California Department of Health Care Services to take steps to expand Medi-Cal eligibility to HIV-positive Californians who are not disabled, Modern Healthcare reports.

The court order stems from a ruling earlier in December 2008 in a case brought by the AIDS Healthcare Foundation (Vesely, Modern Healthcare, 12/23/08).

Background

In 2002, former Gov. Gray Davis (D) signed AB 2197, which required DHCS to encourage Californians who have developed AIDS to enroll in Medi-Cal managed care plans rather than higher-cost fee-for-service plans.

The cost savings from the move to managed care was intended to cover the cost of expanding Medi-Cal coverage for HIV-positive Californians whose conditions have not progressed to AIDS.

Medi-Cal already provides coverage to people with AIDS.

In his ruling, Los Angeles County Superior Court Judge James Chalfant faulted DHCS for not working to implement the law.  The judge concluded that the department:

• Made minimal effort to encourage Medi-Cal beneficiaries with AIDS to enroll in managed care plans;
• Did not assess how much money the move to managed care plans would save;
• Did not calculate reimbursement rates for care providers who treat HIV-positive beneficiaries; and
• Did not pursue other strategies to cover the cost of expanding Medi-Cal to HIV-positive Californians (California Healthline, 12/5/08).

Next Steps

Under the court order, DHCS must seek an agreement with CMS to expand Medi-Cal eligibility and establish payment rates for Medi-Cal managed care plans for services for HIV-positive beneficiaries.

DHCS must report its progress to the court within 120 days (Modern Healthcare, 12/23/08).

The case is Weinstein v. California Department of Health Care Services (Pettersson, Bloomberg, 12/23/08).